What are the recommended eye drops for a child with allergic conjunctivitis?

From the Guidelines

For a child with allergic conjunctivitis, the recommended eye drops are dual-action agents, such as olopatadine (Pataday, Patanol) or ketotifen (Alaway, Zaditor), which possess both antihistamine and mast cell stabilizer activities.

Key Characteristics of Recommended Eye Drops

• These dual-action agents have a rapid onset of action, typically within 30 minutes, making them suitable for acute and longer-term treatment of allergic conjunctivitis symptoms 1.
• They are available in various formulations, including olopatadine (Pataday, Patanol) and ketotifen (Alaway, Zaditor), which have been shown to be effective in preventing or treating ocular itching 1.

Considerations for Treatment

• Antihistamine eyedrops, such as olopatadine, may be tried in mild-to-moderate cases, but their effectiveness in children under 7 years is uncertain 1.
• Mast cell stabilizers, such as cromolyn (Opticrom, Crolom), have a slow onset of action and may require several days of treatment before optimal symptom relief is achieved, making them more suitable for prophylactic or longer-term treatment of chronic ocular allergies 1.
• Topical NSAIDs, such as ketorolac (Acular), reduce prostaglandin production involved in mediating ocular allergy, but their use is generally limited to temporary relief of ocular itching caused by seasonal allergic conjunctivitis 1.
• Ocular corticosteroids, such as loteprednol etabonate (Alrex), should be reserved for more severe symptoms of allergic conjunctivitis due to the risk of vision-threatening side effects, including cataract formation, elevated IOP, and secondary infections 1.

Additional Guidance

• The choice of eye drops should be based on the severity of symptoms, the presence of any underlying conditions, and the patient's response to treatment 1.
• It is essential to follow the recommended dosage and administration instructions for the chosen eye drops to minimize the risk of adverse effects and ensure optimal efficacy 1.

From the Research

Recommended Eye Drops for Allergic Conjunctivitis in Children

The following eye drops are recommended for the treatment of allergic conjunctivitis in children:

• Antihistamines, such as ketotifen fumarate 0.025% ophthalmic solution 2
• Mast cell stabilizers, such as sodium cromoglycate 3
• Dual-action agents, which combine antihistamine and mast cell stabilizing properties 4
• Corticosteroids, such as loteprednol etabonate or fluorometholone, for short-term use in severe cases 5
• Immunosuppressive drugs, such as topical tacrolimus, for long-term use in severe cases 6

Considerations for Treatment

When selecting eye drops for allergic conjunctivitis in children, consider the following:

• The severity of symptoms and the presence of any comorbidities 3
• The potential for side effects, such as steroid-induced cataract or glaucoma, with long-term use of corticosteroids 5
• The importance of preservative-free formulations to avoid disrupting the delicate balance of the ocular surface 4
• The need for regular follow-up and monitoring to adjust treatment as needed 6, 2

Specific Conditions

For specific conditions, such as:

• Vernal keratoconjunctivitis, consider topical tacrolimus or corticosteroids 3, 6
• Atopic keratoconjunctivitis, consider topical tacrolimus or corticosteroids, and treatment of lid eczema with tacrolimus or pimecrolimus ointment 3, 6